January 2008 Update - Walking With Braces

Update: January 2008 - Braces With Walker

Much of the summer months of 2007 were spent using the ‘sit-to-stand’ frame which, with the help of counterweights helped me stand. Leg muscles were strengthened by repeatedly sitting and standing for ever increasing periods of time. As muscles strengthened and balance improved, the counterweights were reduced until I was standing unassisted-hoisting my full weight under my own power.

September 2007: An orthotics specialist met with my physio and myself in order to fit me with leg braces. In spite of my being able to stand under my own power within the frame, muscles still did not work in unison and in the proper sequence . Ligaments did not hold the joints in proper position due to the year of inactivity. My legs could raise me but couldn’t hold me upright unassisted as my knee joints would hyperextend and I would begin to topple over. Braces were cast using a fast setting compound on a cloth like material wrapped around my legs. Once set, they were removed and used as a mould in which high density plastic would form a sleeve like brace extending from the sole of the foot almost to the crotch. Stainless steel locking hinges joined the upper thigh section to the calf section. Once in the standing position the hinges would lock and walking resembled “waddling” like a duck or like Frankenstein in the movies. The braces could be unlocked using a lever behind the knee. Once the knee joints strengthened and muscle “memory” returned to hold the leg in proper alignment, it is my understanding that the braces would be “cut down” to below the knee cap.

September 2007 to January 2008: There was some difficulty in just standing in the braces for any length of time as the braces held me in the proper upright posture. My Achilles tendon had shortened from non-use and as a result I was unable to stand flat. With my feet flat on the ground, I wouldn’t manage to stand perpendicular to the floor. I would lean backwards. I’m finding it difficult to stretch out the tendon so that the foot is flexible and that the feet don’t make me fall over backwards. The same year long activity has tightened my lower back muscles - causing them to resist my efforts to straighten upright and they ache when standing for any length of time. Over this time period I progressed from needing assistance in getting upright in the braces, to getting up with relative ease and walking the parallel bars back and forth repeatedly. The length of the parallel bars is about 10-12 feet and I would walk the length, turn and come back - repeating about 4 to 6 times before resting.

January 2008: Graduated from the parallel bars to the walker. The walker is an alluminum frame with Teflon sliders on the rear posts and wheels on the front posts. Because the walker isn’t attached to the floor as the parallel bars are, it was more difficult to stand up as the there was nothing ‘anchored’ from which to haul myself up. Once up I would walk up and down the hospital hallway about 100 meters at a time, and return - usually twice per session.

Walking with the braces and walker is now done three times a week within my hour session. A slow process - trying to undo a year’s inactivity an hour at a time, less than 3 hours per week. Fatigue sets in quickly and endurance has to be regained.

February 2008: My physiotherapist thought that massage therapy on my tight ham-strings, quads, calves and Achilles tendons would help in loosening them up. After an hour assessment session, a half hour weekly session was decided upon - for as long as the insurance coverage lasted.
I continue to walk weekly with the braces and walker, receive massage therapy on the lower limbs once a week and have a pool session once a week.

Time line - Summary of Change of Sensations No. 2

Update: September 2007
Time line - Summary of Change of Sensations No. 2;

Firstly a description of the last few months progress and observations then an update of the time line summary.

I am still amazed at the amount of muscle atrophy or at least ‘weakness’ that I had from my time being bed bound. During these months I continued to improve immensely with strength and leg mobility. The use of the Biodex, the Standing Frame (Sit to Stand Apparatus) and the pool has been immensely beneficial in regaining both. Nerve pain (burning) not is still constantly present in the feet but is usually at ankle level and below and of a low to moderate intensity. On occasion it can extend up to the knees and the intensity can increase to where it is a constant distraction. I haven’t been able to link the amount and extent of the burning to any outside factors such as exercise or diet etc. It seems it just happens.
The absolutely annoying leg spasms continued to plague me but not during all my waking hours as when in the rehab hospital. Spasms continued to come after intense exercise, usually in the evenings and one leg would start jerking uncontrollably, perhaps once every 3 to 5 seconds, either for an hour or up to perhaps 6 hours. At the worst, spasms can be so strong that if can feel as if the leg might pull itself out of joint Lying in bed I sometimes felt I could knee myself in the chest from these involuntary spasms. Very distracting and annoying!!!

As of about 10 -14 days ago, these strong spasms seem to have disappeared. (Knock on wood). I still periodically get smaller, milder spasms lasting a few minutes to an hour but I can live with those. The medication Baclafin use to combat spasms seemed ineffective during the last year and half as while I was on the highest possible oral dose, legs continued to “dance”. What I did find was that without the Baclafin, the actual jerking or spasms remained at about the same rate, however the drug combated muscle tension and the tendency for my legs to clamp together and the motion be more stiff.
Overall, I found that as I regained motion, I regained muscle tone and when this progressed, the muscular spasms lessened. My legs have regained all motion other than the muscles used to move the foot at the ankle and below. It was amazing to see how much trunk and abdominal tone I had lost. This resulted in severe back spasms which were at their worst first thing in the morning upon waking. I would almost be thrown into an arch with my back rising above the bed’s mattress. During the last month I found that I had the ability to turn onto my side and relieve the pressure on my butt. This was an immense relief!! The additional benefit from this rolling action was that it began to strengthen abdominal muscles and the oblique muscles further assisting the twisting and rolling action. It has been getting easier to turn on my side as a result. Lying on my side, I would attempt to raise my leg as in doing “half scissors”. This was almost impossible when I first attempted but now I can raise the straightened leg quite high and hold it. It still takes a bit of effort but it is getting stronger each week.
Bench work at physiotherapy has now been concentrating on these abdominal and trunk muscles as well. The pool has been instrumental in demonstrating the weaknesses in these muscles and helping to improve them.

Leg Braces:
In late August it was determined that I had progressed to where I could get leg braces and attempt to learn to walk again. At that time my physiotherapist had contacted an orthotics (1) specialist who measured and cast my legs for custom made braces. These braces hopefully be the first version in a progression that would help me to walk with some normality. These initial braces are huge and unwieldy which extend from the bottom of the foot and encase much of the leg right up to the hips and crotch. The braces lock at the knee once erect and have to be unlocked in order to sit again. The mechanism can be unlocked by an assistant or by the wearer by bumping backwards into a chair. The legs are made out of a plastic resin polymer. have a stainless steel knee hinge and are secured to the leg with Velcro straps. Because the knees lock to prevent me from falling over, I will have to walk like Frankenstein, rolling at the hips and swinging each leg forward in a wobbling like motion. We shall see how this works out. My hope is that the knees will strengthen to the point where the braces can be cut back down and my own knees will move and support me allowing a more normal motion. Standing at the parallel bars will begin next week.

(1) Orthotics - A specialist in bracing and support to assist support the motion of joints and muscles.

Update: September 2007
Timeline - Summary of Change of Sensations;

Late April of 2006 - discover that legs won’t move. Pain and discomfort was attributed to sprained back.

May 15th 2006 - Spinal operation and Laminectomy at T-5 to T-7 level to remove bacterial abscess. Remain paralyzed from lower chest downward. No pain, sensations or discomfort other than the realization of building spasms which peaked around September to October of 2006. These are more of a nuisance than a discomfort or pain.

Mid October 2006 - discover slight movement in legs. Can move knees in and out.

End of October 2006 - discharged for home. Slight movement remains secret.

November 2006 to January 2007 - some improvement in movement.

January 2007 - start to get burning pins & needles nerve pain in legs from knees down. Spasms reduce in frequency and some intensity. Hypersensitivity of nerves in hair follicles and altered sensation of pressure. Can feel temperature changes right down to my ankles.
Legs move freely and smoothly in and out, up and down and in circles when extended straight out. Joints bend at knees but not at ankles and cannot wiggle toes. Proprioreception is lost in the lower limbs. Some jerky motions or spasms in the limbs and back especially when lying in bed. Abdominal muscles regained activity and can sit upright with out much difficulty and without support. Rectal sphincter control has improved immensely allowing me to abandon a forced bowel routine.

End of May 2007 - motion continues to improve although more slowly. Spasms surprise me now and then and sometimes show up in the evenings after prolonged sitting or vigorous therapy. Burning pain or tingling remains and can move up or down the legs from feet to ankles or knees but is less severe than earlier. Perhaps some improvement in proprioreception.

May-October 2007 - Range and extent and strength of limb mobility has improved immensely over the last few months and within the last 20 - 14 days, intense leg spasms have all but disappeared. Minor spasms and jerks might still occur but are not nearly as severe or last as long as those previously. Nerve pain still is present, usually below the ankles but it too seems to be less intense and annoyingly distracting as previously. Abdominal and trunk muscle tone are being worked on. Next week I will begin trying to stand and walk with leg braces at the parallel bars.